Eco-Friendly Dentistry

According to the Eco-Dentistry Association, eco-friendly dentistry (ie, green dentistry) is "a high-tech approach that reduces the environmental impact of dental practices and encompasses a service model for dentistry that supports and maintains wellness." It is designed to meet "the needs of millions of wellness lifestyle patients and helps dental professionals protect planetary and community health as well as the financial health of their practices.¹

To promote environmentally friendly and greener practices, the American Dental Association (ADA)² and the Eco-Dentistry Association¹ offer various approaches that general dentists and emergency dentists can employ to address waste reduction, conserve energy, implement reusable and environmentally friendly products, and more.

Because some dentists are only running small practices, they might believe that they are not having a significant enough impact to adversely affect the environment. This is incorrect! Many would be surprised to learn how much pollution and toxic waste that a single dental practice generates daily. There are many ways that practitioners can reduce their contribution of waste and pollution, including the following:

• Promote digital dentistry. Although many dental practices have switched to digital x-ray systems, those still relying on conventional x-ray systems utilize 4.8 million lead foils and 28 million liters of x-ray fixers every year. This amounts to approximately 65% to 75% of the total global burden of dental waste. Simply by switching to a more eco-friendly, precise, and energy efficient digital x-ray system, you can substantially impact your effect on the environment.
• Say no to mercury fillings. The amount of mercury present in one or two dental fillings may not be sufficient to harm the environment; however, the combined release from millions of dental fillings worldwide is certainly an environmental issue. The US Environmental Protection Agency (EPA) estimates that more than 103,000 dental offices in the United States continue to use dental amalgams for restorations, contributing to the release of more than 5.1 tons of mercury into publicly owned treatment works each year, which ultimately finds its way into the environment.³ The agency suggests that by installing amalgam separators, dental offices can significantly reduce this number and take a massive leap toward green dentistry.³ Better yet, why not stop contributing to amalgam waste in the future by eliminating your use of it altogether and wholly switching to BPA-free, resin-based fillings?
• Reduce toxicity from other metals. Dental offices also discharge other metals, such as silver and lead, which further burdens the environment. Using metal-free dental materials is the way to move forward into an environmentally friendly future.

Despite their small size, dental offices consume large amounts of power. From the operation of the dental chairs and handpieces to the x-ray machines, sterilization units, 3D scanners, 3D printers, chairside milling machines, and more, virtually every piece of equipment in the dental office requires electricity to operate. The consumption of water is also significant. Although some of this is unavoidable, the ADA offers recommendations and suggests steps that practitioners can take toward running a more energy-efficient practice, including the following²:

• Using a programmable thermostat to save on heating and air conditioning costs
• Planning the dental office layout to maximize airflow and light
• Investing in an energy efficient hot water heater and appliances
• Installing motion detectors and timers for lights and sensor-operated, low-flow fixtures
• Using ceiling fans to reduce air conditioner usage
• Switching to water-saving toilets
• Investing in solar electric panels and water heaters
• Maintaining indoor plants
• Using e-receipts instead of paper
• Walking or biking to the office to reduce overall carbon footprint

Many of the dental instruments and other pieces of equipment used in dentistry are disposable. Consider the environmental impact of all of it being disposed of into publicly owned treatment works. Why not switch to using reusable instruments and equipment when possible? For example, if you aren't already, you could start by using sterilizable stainless steel trays. You could also consider using reusable cups and water syringes that can be conveniently sterilized in the dental office.

Ultimately, all dental practices will have to switch to greener dental materials to reduce the profession's negative impact on the environment in the future. If you are implementing some green dental products, a good starting point may be the list of green products presented on the Eco-friendly Dentistry Association's website.⁴

No matter how many reusable items you employ, you will still have to rely on some disposable products. Instead of just discarding them all as waste, why not focus on recycling when it's possible? From the old magazines and newspapers in the waiting area to dental office supply boxes and even nonfunctional dental equipment-much of your practice's waste can be easily recycled. At a minimum, the ADA recommends recycling the big five: glass, plastic, paper, aluminum, and steel. If traditional x-ray film is used, the lead foil, fixer, and developer solutions can be recycled, and items such as printer toner cartridges and vacuum pump filter screens can be recycled as well.² Disposable items are necessary; however, in these cases, efforts should be made to select biodegradable products. Why not start by bringing your lunch in biodegradable bags?

The first step toward becoming an eco-friendly dental practice is to convince and motivate your staff regarding the idea. You cannot implement any initiatives or drastic changes unless your entire dental team is on board. Start by making a few small changes at a time. It is easier to develop buy-in from staff with small changes.

In addition, you can also motivate your patients to use environmentally friendly oral hygiene products. There are numerous eco-friendly oral care products available on the market, including bamboo toothbrushes and tongue cleaners, biodegradable dental floss, and whitening products that do not contain harmful chemicals. Patients can also be educated about water usage and waste. The EPA estimates that we waste more than 4 gallons of water each time that we leave the faucet on while brushing our teeth.⁵ Let's motivate our patients to conserve water and help save our environment.

Switching to move toward a greener, more eco-friendly dental practice is not an easy task, but it's doable. Even a small effort on our part can have a significant environmental impact. So, let's begin by initiating small, achievable changes that will serve as the foundation for running environmentally friendly practices in the coming years.

Dr. Mehmood Asghar is an assistant professor in dental biomaterials at the National University of Medical Sciences in Rawalpindi, Pakistan.